Rodolfo Morice, M.D., shares the stories of patients and family members when he talks about the role of pulmonary medicine at MD Anderson.
First, he remembers a man with renal cancer who developed tumors in his airway. No treatment worked, but Morice was able to remove the tumors and allow the man to breathe.
Three years later, when the cancer metastasized and nothing more could be done, the man thanked Morice, “You’ve given me three good years. In that time, my son got married and my grandson was born.”
And there’s the young woman who wrote him a thank-you letter, saying, “You don’t know me, but years ago, when I was 5 years old, you treated my mother. I’m grateful I had her for another five years.”
Lungs. We take them for granted. Yet, respiratory rate is one of the four vital signs, along with blood pressure, pulse and temperature. Doctors want to know: Are we breathing easy? Or are we laboring for every breath?
“For many years, however, pulmonary specialists in the community didn’t believe there was much for the treatment of lung cancer outside surgery,” says Morice, professor in the Department of Pulmonary Medicine.
“In fact, 25 years ago, the American Thoracic Society reported that only 11% of lung cancer patients were even referred to an oncologist because if the disease was too advanced for surgery, there was little hope.
“On the other side, the oncologists were so challenged with treating the cancer that there was not much focus on the side effects of the disease and its treatments.”
Research discoveries over the last quarter century have changed patients’ options.
“Our goal is to improve patients’ quality of life during treatment and to keep them cancer-free and healthy,” he says.
A broad spectrum of pulmonary care
In 1999, Burton Dickey, M.D., joined MD Anderson with a mandate:
- to contribute to the institution’s mission in all four areas: research, patient care, education and prevention, and
- to grow what consisted then of three pulmonologists in the Department of Medical Specialties into the Department of Pulmonary Medicine.
In 12 years, Dickey, professor and department chair, and his colleagues have continued to expand this charge. They perform advanced technological procedures, address sleep disorders and the need for pulmonary rehabilitation.
They also conduct basic and clinical research to better understand and develop interventions for:
- pneumonia (causes and prevention of this pulmonary infection),
- pleural effusions (the buildup of fluid between the layers of tissue that line the lungs and chest cavity),
- lung injury due to chemotherapy or radiation, which lowers ability to fight infection,
- lung cancer staging and palliation (alleviation of symptoms) and
- hemostasis (stoppage of bleeding) and thrombosis (formation of blood clots).
Morice is a leader in the emerging field of interventional pulmonology, which focuses on the use of advanced technologies to diagnose and treat a variety of thoracic disorders.
With bronchoscopies, interventionalists can diagnose tumors in lungs and airways and sample lymph nodes in the mediastinum (chest) to determine if the cancer has spread.
They can also look at gene expression or remove tumors to keep airways open to allow the patient to breathe and undergo definitive cancer treatments or for palliative care.
With catheters and pleuroscopies, they can drain fluid off the lungs and keep fluid from returning to help patients breathe. They also provide a diagnostic work-up to determine the correct treatment based on the cause.
Morice, section chief of this specialty, also plays a major role as an educator, helping ensure, through medical rotations and hands-on conferences, that practicing physicians acquire the skills and competency needed to provide these services.
Doing something for the patient
For his part, Morice has witnessed a monumental increase in the knowledge of pulmonary medicine. When he arrived at MD Anderson 26 years ago, he dealt primarily with a patient’s internal medicine issues prior to surgery.
Today, the department has 15 faculty members, who in addition to the list above:
- actively participate in early detection and lung chemoprevention trials;
- offer rotations for medical students, a fellowship program and annual training conferences; and
- study pulmonary complications associated with bone marrow transplantation.
At the end of the day, however, what is most important, he says, is that, “While we can’t always cure patients’ cancer, there are times when we can do something to improve their quality of life. We can help them breathe.”